2000 Participants Needed

Integrated Care Plan for Health Care Quality and Access

KA
MG
HK
Overseen ByHarpreet K Jaswal, MPH
Age: 18+
Sex: Any
Trial Phase: Academic
Sponsor: University of Calgary
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)

Trial Summary

What is the purpose of this trial?

The Integrated Care Pathway (ICP) model can reduce hospital readmissions and emergency department (ED) visits while improving continuity of care. This model was first developed at the University Health Network in Toronto, Ontario, and has been adapted for patients at high risk of readmission and with medical/social vulnerability admitted to general medical units in the hospitals in Calgary, Alberta. The study will evaluate the ongoing adaption and implementation of the ICP model in Calgary. ICP patients will receive the following tenets of care: 1. Continuity of care - After determining the patient's inventory of needs, study participants will then be assigned to an ICP team member who will follow them throughout their hospitalization to support their discharge planning and to advocate for their needs in hospital. 2. Intensive Case Management - The ICL will liaise with hospital, primary care and community partners to develop a tailored complex care plan to support the patient's transition home. This will be documented in the hospital's electronic medical record (EMR) and incorporated into the discharge summary at the time of hospital discharge. 3. Post-discharge support * 24 hour access to phone support within the first 2 weeks of discharge from hospital, leveraging the ICP, community stakeholders and Healthlink from Alberta Health Services. * Long-term support and follow-up in the community up to 90 days with goal of implementing and adapting the complex care plan to help patients access services and manage their chronic health conditions. The main study objectives are: 1. To adapt and implement the ICP in Calgary's 4 hospitals over a 3 year period. 2. To evaluate the implementation of the ICP in Calgary leveraging the Quintuple Aim Framework. Methods: Patients enrolled in ICP will be compared with comparator patients in control sites to evaluate the model's effectiveness. Since the ICP is new to Calgary, the research team will be evaluating how well it performs compared to usual transitions in care by collecting data to learn about: 1. How patients and their caregivers experienced their time in hospital and transition home. 2. How healthcare providers feel about the ICP's impact on patient care. 3. The ICP's impact on patient health outcomes, 4. The use of hospital resources, and the cost of providing care. 5. The ICP's impact on equity, or fair access to healthcare resources and services.

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on care coordination rather than medication changes, so you may not need to stop them, but it's best to confirm with the trial coordinators.

What data supports the effectiveness of the treatment Integrated care plan?

Integrated care plans, which aim to improve coordination and continuity of care, have shown modest benefits for patients with complex or chronic illnesses, although evidence is sometimes conflicting. They are believed to enhance patient experiences and outcomes, especially when care is personalized and goal-oriented.12345

Is the Integrated Care Plan generally safe for humans?

The research articles focus on adverse events in healthcare settings, highlighting the importance of improving patient safety and preventing adverse events through better integration, communication, and education. However, they do not provide specific safety data for the Integrated Care Plan itself.678910

How is the integrated care plan treatment different from other treatments?

The integrated care plan is unique because it combines various healthcare services to provide seamless and efficient care, focusing on better coordination and delivery of care, unlike traditional treatments that may be fragmented and less coordinated.511121314

Research Team

MG

Michelle Grinman, MD FRCPC MPH

Principal Investigator

University of Calgary

Eligibility Criteria

This trial is for patients at high risk of hospital readmission and with medical or social vulnerabilities admitted to general medical units in Calgary hospitals. It aims to improve care quality and access, focusing on those who might benefit from an integrated care plan.

Inclusion Criteria

I can make my own medical decisions or have someone who can.
Patients must reside in Calgary Zone
Caregivers must be informal (friend/family) of a patient enrolled in ICP and provide support in the form of care at home, transportation, going to appointments, managing finances, etc. They must also provide informed consent to participate in the study
See 5 more

Exclusion Criteria

I am 17 years old or younger.
I am admitted to a surgery, obstetrics/gynecology, or psychiatric ward.
Patients without valid health coverage data
See 7 more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Hospitalization and Discharge Planning

Participants are assigned to an ICP team member who supports discharge planning and advocates for their needs during hospitalization.

Varies based on hospitalization
Continuous in-hospital support

Post-discharge Support

Participants receive 24-hour phone support for the first 2 weeks post-discharge and long-term support up to 90 days to implement and adapt the complex care plan.

Up to 90 days
Phone support and community follow-up

Follow-up

Participants are monitored for safety and effectiveness after discharge, with follow-up visits to primary care and subspecialty care.

3 months
Follow-up visits at 7 days, 1 month, and 3 months

Treatment Details

Interventions

  • Integrated care plan
Trial Overview The study tests the Integrated Care Pathway (ICP) model against usual care. ICP includes a personalized team member support during hospitalization, intensive case management, post-discharge phone support within two weeks, and community follow-up for up to 90 days.
Participant Groups
1Treatment groups
Experimental Treatment
Group I: Integrated care pathway supported by the integrated care leadExperimental Treatment1 Intervention
Enrolled patients in the ICP will then undergo more assessment by the Integrated Care Lead to develop a preliminary inventory of their needs for transitioning back to their health home. Patients will then be assigned an Integrated Care Lead with expertise in managing their particular needs. This will result in the development of a complex care plan that is co-designed with a patient's acute and community care team (eg: primary care, home care, community services, hospital medical team etc). This plan will be documented in Connect Care and incorporated into the discharge summary at the time of hospital discharge. (see Appendix 2) Calgary Zone Integrated Care Program will then provide: * Continuity of care with the assigned ICP team member(s) throughout their hospitalization and connection with community resources and services in the process of complex discharge planning. * Efficient use of healthcare resources by reducing duplication of services and systematically screening for unmet

Find a Clinic Near You

Who Is Running the Clinical Trial?

University of Calgary

Lead Sponsor

Trials
827
Recruited
902,000+

Canadian Institutes of Health Research (CIHR)

Collaborator

Trials
1,417
Recruited
26,550,000+

Findings from Research

A symposium with 31 healthcare professionals highlighted that preventing adverse events in community care requires a multi-faceted approach involving policy changes at various levels, including system integration and improved communication among providers.
Key recommendations from the symposium include prioritizing education for clinicians and caregivers, enhancing organizational culture, and leveraging technology to improve patient safety and reduce adverse events.
Adverse events in community care: implications for practice, policy and research.Masotti, P., Green, M., McColl, MA.[2019]
A total of 417 adverse event cases leading to death were reported in Brazil from June 2014 to June 2016, primarily affecting adults and the elderly, with hospitals being responsible for 97% of these cases.
The most common incidents were categorized as 'failures during health care,' highlighting a significant need for improved reporting and investigation of such events, as only 5% of cases were further investigated by the notifying units.
Registry of adverse events related to health care that results in deaths in Brazil, 2014-2016.Maia, CS., Freitas, DRC., Gallo, LG., et al.[2019]
In a study analyzing 1009 ICU days, 230 adverse drug events were identified in 79 patients, with the most frequent issues being hypoglycemia, prolonged activated partial thromboplastin time, and hypokalemia.
The occurrence of adverse drug events was significantly linked to higher severity of illness and increased nursing workload, indicating that patient condition and staff demands may influence the safety of drug administration in critical care settings.
Adverse drug events in intensive care units: a cross-sectional study of prevalence and risk factors.Seynaeve, S., Verbrugghe, W., Claes, B., et al.[2013]

References

Introducing anticipated recovery pathways: a teaching hospital experience. [2019]
Experiences and Reported Outcomes of Patients and Caregivers Enrolled in an Integrated Care Program for Thoracic Surgery: A Qualitative Evaluation. [2023]
Assessing the effectiveness of integrated interventions: terminology and approach. [2007]
A person-centered integrated care quality framework, based on a qualitative study of patients' evaluation of care in light of chronic care ideals. [2023]
Assessing healthcare professionals' experiences of integrated care: do surveys tell the full story? [2018]
Adverse events in community care: implications for practice, policy and research. [2019]
Registry of adverse events related to health care that results in deaths in Brazil, 2014-2016. [2019]
Drug-induced acute myocardial infarction: identifying 'prime suspects' from electronic healthcare records-based surveillance system. [2022]
Adverse drug events in intensive care units: a cross-sectional study of prevalence and risk factors. [2013]
[Study of adverse events in private healthcare. Confidence project for patient safety]. [2012]
Implementation of integrated care for patients with cancer: a systematic review of interventions and effects. [2022]
Integrated care for MS patients. [2007]
[Integrated care: the right way for the future?] [2022]
Measuring Processes of Integrated Care for Hospital to Home Transitions. [2022]
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